What is Medical Billing Management?

Medical billing is submitting and following up on claims with health insurance companies to receive payment for services rendered by a healthcare provider or medical billing company.
To better understand what medical billing management is, let’s define the parties in this process:

  1. The patient
  2. The healthcare provider (hospitals, physicians, physical therapists, emergency rooms, outpatient facilities, and other places where medical services are performed)
  3. The insurance company or payer

So, the role of medical billing management is to arrange payment between these three parties. Specifically, the billing manager ensures that healthcare providers are compensated for their services by billing patients and payers.
The process looks the same for most insurance companies, whether private companies or government-sponsored programs. This interaction is called the billing cycle, sometimes called Revenue Cycle Management.

Revenue Cycle Management (RCM) administers financial transactions resulting from medical encounters between medical billing parties.
From registration and appointment scheduling to the final payment, they are all a part of the revenue cycle.

Here is what’s involved in the revenue cycle:

Data Collection

Inputting data about a patient: its name, birth date, and the reason for a visit, and insurance information: the name of the insurance provider and the patient’s policy number verified by medical billers. This information is used to set up a patient file that will be referred to during the medical billing process.

Claims Transmission

Passing claims from the care provider to the payer.

Claims Management

Includes claims processing, vetting, and analysis if it’s rejected.

Automate processes in healthcare

A/R Follow-Up

Ensures that medical billing companies have a way to recover overdue payments. Most responsibilities include looking after rejected claims, exploring partial payments, and reopening claims to receive maximum reimbursement from insurance companies.

Reporting

Includes financial data, management information, and key performance indicators to recognize the results and to get an overview of the state of the process.
So, it’s crucial to organize the medical billing system as an essential part of Revenue cycle management. With an excellent internal RCM setup, healthcare providers can quickly resolve issues and ensure a steady revenue.

Medical Billing Management Overview

Medical billing management is critical individual in the health care system.
To overview the whole process, let’s consider it from the position of the responsibilities associated with the role of medical billing manager. The medical billing manager’s most important task is overseeing the billing process of patients and insurance companies.

The job includes collecting, analyzing, and reviewing data to determine the appropriate charges and managing patient accounts receivable.

  1. Cooperating with insurance companies regarding insurance contracts
  2. Training and supervising team members to ensure that all of them always follow proper medical coding practices
  3. Accepting fees from patients, insurance firms, and government health programs
  4. Arranging and maintaining all paperwork and records
  5. Communicating with clients about their bills
  6. Tracking payments made by insurance agencies and patients (analyzing and reviewing data to determine the appropriate charges and managing patient accounts receivables)
  7. Testing software programs to ensure the efficiency of the system

Maintaining proper inventory of supplies such as forms, envelopes, stamps, medical record paper, etc.

A medical billing manager also ensures that employees and customers follow all policies.

Lots of the tasks above are manual and repetitive. If you approach medical billing management from the automation point of view, then RCM will become much more efficient.

5 Tips to improve medical billing management processes

Automate processes with RPA

Automation deals with every critical aspect of medical bills that can seem tedious to a person. RPA payment solutions can improve fees by automatically sending patient bill notifications via text or email.

According to UiPath’s definition, Robotic Process Automation (RPA) is a software technology that makes it easy to build, deploy, and manage software robots that emulate human actions interacting with digital systems and software. Like people, software robots can understand what’s on a screen, complete the proper keystrokes, navigate systems, identify and extract data, and perform a wide range of defined actions.

Why RPA can be a perfect decision to implement in your medical billing:

  • Proper Documentation – in medical billing, where there is lots of administrative paperwork, error-free documentation should be the goal of every healthcare provider.
  • Lower Costs – automated medical billing processes free time and leave extra funds to focus on more patient-oriented tasks and improve the cash flow.
  • Streamlined Medical Billing – all medical billing managers implementing RPA can attest that using an outdated billing system risks many unorganized claims processes and unnecessary errors.

There’re a lot of processes where RPA can be implemented. For example, check one of the use cases to see medical billing automation by optimizing the process of syncing health data.

Offer flexible payment plans

Payments are crucial in the overall customer experience but can sometimes be an afterthought. You can propose a card on file, online prices, and payment plans that offer patients convenient and private ways to pay, improving medical billing efficiency and boosting revenue.

Appeal denied claims

There’s a 3 – 4% chance a claim will be denied even if it’s accurately coded. This risk increases when there are problems with the process, rising to 15 to 25%. To get paid for these services, a medical billing department needs to follow up on these denials and respond as necessary.

Reduce Missed Appointments

No-shows and late cancellations can cost thousands of dollars each year. Adding a cancellation policy with a fee can help; offering patients a way to do virtual visits from their homes can be effective. Patients who don’t need to brave traffic or take time off to see you are much less likely to skip their appointments.

Educate your team

When properly trained and constantly updated, employees can provide the best customer experience and deliver high-quality tasks faster. Organizing different training programs and career development opportunities expresses your desire to invest in people, and your employees will reciprocate with more loyalty and better results.

Conclusion

Medical billing management is challenging and rewarding but can be improved and more manageable.

Innovative improvement always leads to a company’s growth and achieving its goals. Therefore, it’s better to provide enhancements to decrease manual tasks, so you and your employees can concentrate on strategic ones. So, in general, medical billing management becomes more quality.

Optimize your medical billing management processes with Robotics Process Automation. So, you optimize the exciting processes fast and get the maximum value.

We provide RPA consultancy services and are ready to help to find out what processes can be improved in your company and build an automated medical billing management system now!

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Yana Pokora

Content Manager at Flobotics. A researcher of automation implementations across industries and their impact. Marketing & dog lover.

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